Gender, Work and the Mid-twentieth century Hospital

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At a recent event I attended on the history of wound care I, possibly rashly, asserted that mid-twentieth century hospitals were run on a daily basis by women with doctors playing only a small part in the quotidian life of the institution. My bravado owed something to my work on inter war hospitals where most of the medical staff were voluntary appointments who possibly visited their patients on a daily round before returning to their private practice. The management of patients was normally in the hands of a small coterie of trainee house staff whose number depended on the size and purpose of the institution and the proximity of a medical school. In the municipal and ex-poor law hospitals doctors were even less common. Normally the institution would have a Medical Superintendent who might be assisted by a deputy and a Medical Officer in charge of obstetrics – though this post was likely to be held by a woman. Even in huge municipal hospitals like St James’ in Leeds resident or even regularly attending medical staff might number five or less.

But I was still concerned I may have gone over the top. However, while looking for some information on hospital beds in Sheffield I unearthed a copy of the Sheffield Regional Hospital Board’s report on their first five years of operation following the founding of the NHS. The data wasn’t much use for my purposes but my attention was caught by the photograph section. The images are reproduced here in full as they confirm, vividly, the extensive role of women workers in the region’s institutions and the absence of men in medical, patient management or caring roles.

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The first feature to stand out is the variety of technical roles undertaken by nursing and female scientific and technical staff. In the image above they are working with children to correct squints, a department introduced into Sheffield’s hospitals in the mid-1930s. Immediately below we see a female radiographer while in the next picture two nurses are overseeing a patient in a modern ‘iron lung’. Admittedly in this case the role of one of the nurses is less impressive – she is holding a newspaper for the male patient to read!

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The women in the next two shots are engaged in the kind of work one might expect of female staff in this period – one feeding an infant the other teaching young patients in the hospital school (probably in a TB sanatorium). But the second pair are more challenging. The first shows two you women scientists in the pathology laboratory. Evidence from across the country, and internationally, shows that routine scientific testing was undertaken almost entirely by women at this time. They rarely received credit as the chief pathologist but they were the back-bone of the scientific revolution in the mid twentieth century hospital. Moreover, they also dominated the staffing of radiography, X-Ray and probably radiology departments, the staff member shown here working one of the most up to date pieces of equipment that required considerable judgement to use effectively.

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Certainly men could be found in and around the wards – for example as porters and orderlies or in traditional non-medical trades like decorators, electricians and engineers – but their therapeutic interventions were limited. The available illustrations show them limited to occupational therapy and rehabilitation – supervising in the gym or the workshop. Yet even then there is evidence that nurses supervised much of the early physiotherapy and undertook muscle manipulation and massage.

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Indeed the only senior medical role occupied by a man in the collection of images as tutor in a class for nurses. Interesting, although the caption refers to Student Nurses there are a large number of men in white coats who one can assume are medical students.

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The final two images of staff once again confirm the dominance of women, that above showing nurses, probably at the King Edward VII Orthopaedic Hospital for Children, delivering water therapy for children who spent much of their time bed-bound. The woman below occupied a role which had been identified with female workers from its introduction in the late nineteenth century – the almoner. Initially employed to ensure those who could pay for treatment did so and those who couldn’t or didn’t have to were exempt, by the 1930s they were already engaged in extensive social work activities. By the time the NHS was fully operational they job had become entirely social, managing discharge arrangements, ensuring patients had suitable accommodation and support, possibly arranging convalescence and maybe even charitable support. In the case of this patient it is likely he will not have worked for some time – either because of TB or an accident – and his needs or discharge could be quite extensive.

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Thus, by the time these two characters headed home on their adapted motor trikes it is likely they will have spent almost all of their time in hospital under the ministration of female staff who not only undertook the expected caring roles of the traditional hospital but were also are the heart of the new scientific, technological and therapeutic regimes introduced in the second quarter of the twentieth century. Women may have made beds, fed babies and turned the pages of patients’ newspapers but they also worked the most up-to-date machines, conducted the laboratory experiments and tests fixed squints and ensured the safe discharge of patients. Indeed in the kind of long stay institutions depicted here the doctor was still marginal to the patients recovery but not because these were not curative institutions. As these images suggest women were central to the curative high tech regimes of the mid-twentieth century in a way that is rarely, if ever, revealed.

All the images in this post are taken from: Sheffield Regional Hospital Board, Quinquennial Report upon the work of the Sheffield Regional Hospital Board from 1947-1952 (Sheffield, 1953). The images appear between pages 64-65. There are no explicit acknowledgements but this appears at the end of the book.

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